Laith Al-Qamachi

Microbiology of odontogenic infections in deep neck spaces: a retrospective study.

The primary treatment of deep neck spaces odontogenic infection (DNSOI) with suppuration is surgery. Systemic antimicrobial therapy is an important adjunct. The initial prescription of antimicrobial therapy is empirical. Over the last decade we have observed a change in practice with the use of second-generation cephalosporins, in conjunction with metronidazole, replacing benzylpencillin and metronidazole. More recently evidence has emerged suggesting that antimicrobial resistance in nosocomial infections could be related to the widespread use of second and third-generation cephalosporins. This study was therefore initiated to determine whether this change in prescribing was justified. A total of 75 cases were retrospectively identified by scrutiny of the operating theatre data. These patients presented with significant DNSOI that required surgical drainage. Streptococcus milleri and mixed anaerobes were predominant. Only in three cases (4%) there were penicillin-resistant microorganisms. The substitution of benzylpenicillin for cefuroxime as an initial empiric therapy for DNSOI seems likely to have been equally efficacious in the large majority of cases. On the other hand, studies in preference of cephalosporins are based on in vitro trials. A multi-centre randomized controlled clinical trial directly comparing initial empiric second-generation cephalosporin therapy with benzylpenicillin in non-allergic patients is justified.

Ameloblastomas of the mandible and maxilla.

Purpose of reviewThis review focuses on issues in managing ameloblastomas of the mandible and maxilla. We will refer to current practice in the treatment of ameloblastomas based on the available evidence. Recent findingsRecent reviews have been trying to establish natural history, growth patterns and malignant potential. This provides the clinicians and the patients with useful prognostic information. Controversies in management of ameloblastomas in relation to the type, age and site exist. This paper aims to categorize these issues. More recently, the authors have adopted the staged treatment approach as an additional step to ensure margin clearance. SummaryCurrent evidence favours radical resection to provide better control rates. This applies to maxillary lesions of all ages, and solid mandibular lesions in adults (>18 years) where growth has ceased and the patient has matured enough to withstand the impact of resection and reconstruction. Conservative management is advocated for unicystic lesions with good control rates. In children and adolescents, a conservative approach is recommended. This approach aids to minimize both psychological and the impact on growth. Furthermore, most of the lesions are unicystic and the recurrent lesions have been shown to be much smaller and can be managed promptly within a good healthcare system.

Speech and swallowing outcomes following oral cavity reconstruction

Purpose of review This review explores speech and swallowing outcomes following oral cavity reconstruction for treatment of head and neck cancer, with focus on articles published within 2015–2016. Recent findings There is limited recent evidence that explores functional outcomes following oral cavity surgery in the literature; therefore, an overview of the literature describing surgical interventions and their associated functional outcomes is timely. Summary We discuss the challenges associated with achieving adequate surgical margins, alongside optimal functional outcomes. The correlation between the size, site and type of reconstruction with speech and swallowing function are described, along with novel surgical and therapeutic interventions that may reduce treatment morbidity and have the potential to impact positively on quality of life.